Government Programs Compliance Specialist, Senior

Your Role

The Promise Medi-Cal Compliance team oversees and coordinates Blue Shield Promise Health Plan’s (BSCPHP) compliance program. The Government Programs Compliance Specialist, Senior  will report to the Government Programs Compliance Senior Manager. In this role you will be providing assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, or federal and state regulatory requirements.

Your Work

In this role, you will:

• Documents final compliance solutions, identified risks, and mitigation plans in a controlled document 
• Monitors implementation of corrective action plans to ensure on track, risks are identified, mitigation plans are developed; escalates as appropriate
• Summarizes and distributes low to complex federal and state updates to impacted areas 
• Conducts federal and state regulatory compliance verification; where compliance gaps are identified, validates quality, timeliness, and progress of corrective action plans 
• Conducts more complex audits of Medi-Cal functions 
• Manages and maintains Medi-Cal Compliance department activities e.g. development & maintenance of the department audit calendar, CMS, DMHC and DHCS audit calendar, department mailboxes, intranet website, policies and procedures, and other items as needed
• Supports calibration of risk and controls with business units supporting the Medi-Cal line of business
• Develops, prepares, and presents analyses, reports, and recommendations to department management and other stakeholders of federal and state requirements
• Provides day-to-day support guidance to areas that support Medi-Cal products on low to moderately complex inquiries
• Participates in multiple projects or initiatives within and outside of the department and other duties as assigned

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience 
• Requires at least 5 years of prior relevant experience
• Requires managed care health plan compliance department experience
• Knowledge and understanding of Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes
• Strong analytical, regulatory reporting, data reporting including risk assessment and mitigation 
• Competent in Excel, SharePoint, PowerPoint
• Professional certifications and additional degrees a plus